The issue of mandatory vaccination is once again an item of debate in media circles given the recent outbreaks in measles, and fueled this week by the continued inability of politicians to discuss vaccination policy without sounding like anti-science fools.

We’ve had mandatory vaccines for schoolchildren in America since before the Emancipation Proclamation.

The current vaccine debate, unlike those prior ones, is actually motivated by a real problem (the return of diseases presumed previously eradicated) as opposed to conspiratorial musings. There are some basic questions here which are legitimate regarding the protection of the rights of parents, not government, to direct the upbringing of their children. Calls to jail ‘anti-vax’ parents, for instance, strike me as extreme and disturbing. But vaccination is not about protecting the vaccinated so much as it is about protecting others from disease-carriers. Vaccines are properly understood not on the basis of narrow self-interest but as a defense of the human species.

Fundamentally, the protection against life-threatening plague is one of the original reasons government exists. We’ve had mandatory vaccines for schoolchildren in America since before the Emancipation Proclamation. The Supreme Court has upheld that practice as constitutional for over a century, and only the political fringes believe there ought to be a debate about such matters. This is one of the few areas where government necessarily exercises power. Richard Epstein notes the impossibility of turning to the courts for recompense after infection:

The basic soundness of the constitutional recognition of a police power to deal with communicable diseases is beyond dispute. Even in a free state, quarantines are the only reliable remedy to protect the health of the public at large from the spread of disease. It is sheer fantasy to think that individuals made ill could bring private lawsuits for damages against the parties that infected them, or that persons exposed to imminent risk could obtain injunctive relief against the scores of persons who threaten to transmit disease. The transmission of disease involves hidden and complex interconnections between persons that could not be detected in litigation, even assuming that it could be brought in time, which it cannot.

The problem has been the growth of those opting out of vaccination, not due to deeply held religious beliefs or legitimate medical problems or impoverished and irresponsible parents, but because of other concerns. It’s telling that refusing to get your kids vaccinated is the trendy thing among the California elite, even as they decline to embrace other aspects of the Amish lifestyle. Or the Jenny McCarthy lifestyle, for that matter.

The Right To Choose, But Not Without Consequences

I am sympathetic to the idea that some parents believe there are already too many vaccines on the schedule, who have concerns and prefer to delay or space the vaccines out. According to this report, 1 out of every 10 parents already does this. But conceding that parents have the right to delay these shots is not the same as saying they should have the right to prevent such vaccination altogether without consequences.

You shouldn’t be compelled to vaccinate your child, but neither should the rest of us be compelled to pretend like you did.

It’s the failure to deal with those consequences that frustrates me about this debate. If you choose to not vaccinate your children, that is your choice. In the absence of an immediate threat, such as a life-threatening plague or outbreak, the state doesn’t have a compelling reason to administer that vaccination by force or to infringe on your rights. But that doesn’t mean there are no tradeoffs for such a decision. If you choose not to vaccinate, private and public institutions should be able to discriminate on that basis. Disneyland should be able to require proof of vaccination as a condition of entry, and so should public schools. You shouldn’t be compelled to vaccinate your child, but neither should the rest of us be compelled to pretend like you did.

Oliver Wendell Holmes articulated a good libertarian principle when he said, "The right to swing my fist ends where the other man's nose begins." Holmes' observation is particularly salient in the case of whooping cough shots. Infants cannot be vaccinated against whooping cough (pertussis), so their protection against this dangerous disease depends upon the fact that most of the rest of us are immunized. Unfortunately, as immunization refusals have increased in recent years, so have whooping cough infections. The annual number of pertussis cases fell from 200,000 pre-vaccine to a low of 1,010 in 1976. Last year, the number of reported cases rose to 48,277, the highest since 1955. Eighteen infants died of the disease in 2012, up from just four in 1976.
The trend is affecting other diseases as well. In 2005, an intentionally unvaccinated 17-year-old Indiana girl brought measles back with her from a visit to Romania, and ended up infecting 34 people. Most of them were also intentionally unvaccinated, but a medical technician who had been vaccinated caught the disease as well, and was hospitalized. Another intentionally unvaccinated 7-year-old boy in San Diego sparked an outbreak of measles in 2008. The kid, who caught the disease in Switzerland, ended up spreading his illness to 11 other children, all of whom were also unvaccinated, putting one infant in the hospital. Forty-eight other children younger than vaccination age had to be quarantined.
Some people object to applying Holmes' aphorism by arguing that aggression can only occur when someone intends to hit someone else; microbes just happen. However, being intentionally unvaccinated against highly contagious airborne diseases is, to extend the metaphor, like walking down a street randomly swinging your fists without warning. You may not hit an innocent bystander, but you've substantially increased the chances. Those harmed by the irresponsibility of the unvaccinated are not being accorded the inherent equal dignity and rights every individual possesses. The autonomy of the unvaccinated is trumping the autonomy of those they put at risk.

Try A Carrot, Not Just A Stick

So how should we rebalance this autonomy? One suggestion regarding a path forward on public policy regarding vaccination policy: We speak about these topics mostly in terms of state mandates and sticks, but perhaps that’s not the best way. The Australian experience on vaccines, where they tied access to family tax benefits to immunization, illustrates that carrots can be quite effective.

If the decline in MMR vaccination continues, perhaps the federal government could take the step of making access to the child tax credit contingent upon vaccination. If we’re going to have redistributive social engineering in the tax code, it may as well be for children who aren’t carrying disease around Disneyland.